National Institute of Mental Health:

What are psychiatric medications?

Psychiatric medications treat mental disorders. Sometimes called psychotropic or psychotherapeutic medications, they have changed the lives of people with mental disorders for the better. Many people with mental disorders live fulfilling lives with the help of these medications. Without them, people with mental disorders might suffer serious and disabling symptoms.

How are medications used to treat mental disorders?

Medications treat the symptoms of mental disorders. They cannot cure the disorder, but they make people feel better so they can function.

Medications work differently for different people. Some people get great results from medications and only need them for a short time. For example, a person with depression may feel much better after taking a medication for a few months, and may never need it again. People with disorders like schizophrenia or bipolar disorder, or people who have long-term or severe depression or anxiety may need to take medication for a much longer time.

Some people get side effects from medications and other people don't. Doses can be small or large, depending on the medication and the person. Factors that can affect how medications work in people include:

  • Type of mental disorder, such as depression, anxiety, bipolar disorder, and schizophrenia
  • Age, sex, and body size
  • Physical illnesses
  • Habits like smoking and drinking
  • Liver and kidney function
  • Genetics
  • Other medications and herbal/vitamin supplements
  • Diet
  • Whether medications are taken as prescribed.

What medications are used to treat schizophrenia?

Antipsychotic medications are used to treat schizophrenia and schizophrenia-related disorders. Some of these medications have been available since the mid-1950's. They are also called conventional "typical" antipsychotics. Some of the more commonly used medications include:

  • Chlorpromazine (Thorazine)
  • Haloperidol (Haldol)
  • Perphenazine (generic only)
  • Fluphenazine (generic only).

In the 1990's, new antipsychotic medications were developed. These new medications are called second generation, or "atypical" antipsychotics.

One of these medications was clozapine (Clozaril). It is a very effective medication that treats psychotic symptoms, hallucinations, and breaks with reality, such as when a person believes he or she is the president. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. Therefore, people who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. Still, clozapine is potentially helpful for people who do not respond to other antipsychotic medications.

Other atypical antipsychotics were developed. All of them are effective. These include:

  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
  • Aripiprazole (Abilify)
  • Paliperidone (Invega)
  • Lurasidone (Latuda)

What are the side effects?

Some people have side effects when they start taking these medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

  • Drowsiness
  • Dizziness when changing positions
  • Blurred vision
  • Rapid heartbeat
  • Sensitivity to the sun
  • Skin rashes
  • Menstrual problems for women.

Typical antipsychotic medications can cause side effects related to physical movement, such as:

  • Rigidity
  • Persistent muscle spasms
  • Tremors
  • Restlessness.

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can't control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication.

What medications are used to treat bipolar disorder?

Bipolar disorder, also called manic-depressive illness, is commonly treated with mood stabilizers. Sometimes, antipsychotics and antidepressants are used along with a mood stabilizer.

Mood stabilizers

People with bipolar disorder usually try mood stabilizers first. In general, people continue treatment with mood stabilizers for years. Lithium is a very effective mood stabilizer. It was the first mood stabilizer approved by the FDA in the 1970's for treating both manic and depressive episodes.

Anticonvulsant medications also are used as mood stabilizers. They were originally developed to treat seizures, but they were found to help control moods as well. One anticonvulsant commonly used as a mood stabilizer is valproic acid, also called divalproex sodium (Depakote). For some people, it may work better than lithium.6 Other anticonvulsants used as mood stabilizers are carbamazepine (Tegretol), lamotrigine (Lamictal) and oxcarbazepine (Trileptal).

Atypical antipsychotics

Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, antipsychotics are used along with other medications.

Antipsychotics used to treat people with bipolar disorder include:

  • Olanzapine (Zyprexa), which helps people with severe or psychotic depression, which often is accompanied by a break with reality, hallucinations, or delusions7
  • Aripiprazole (Abilify), which can be taken as a pill or as a shot
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)
  • Clozapine (Clorazil), which is often used for people who do not respond to lithium or anticonvulsants.8
  • Lurasidone (Latuda)

Antidepressants

Antidepressants are sometimes used to treat symptoms of depression in bipolar disorder. Fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) are a few that are used. However, people with bipolar disorder should not take an antidepressant on its own. Doing so can cause the person to rapidly switch from depression to mania, which can be dangerous. To prevent this problem, doctors give patients a mood stabilizer or an antipsychotic along with an antidepressant.

Research on whether antidepressants help people with bipolar depression is mixed. An NIMH-funded study found that antidepressants were no more effective than a placebo to help treat depression in people with bipolar disorder. The people were taking mood stabilizers along with the antidepressants.

Person-Centered Planning and Service Delivery Requirements

Every home and community-based services program licensed under chapter 245D is required to provide services in response to each person’s identified needs, interests, preferences, and desired outcomes as specified in the coordinated service and support plan and the coordinated service and support plan addendum, and in compliance with the requirements of the 245D Home and Community-Based Services (HCBS) Standards.

As required in section 245D.07, subdivision 1a of the 245D HCBS Standards, 245D licensed programs must provide services in a manner that supports each person’s preferences, daily needs, and activities and accomplishment of the person’s personal goals and service outcomes, consistent with the principles of:

Person-centered service planning and delivery that:

  • identifies and supports what is important to the person as well as what is important for the person, including preferences for when, how, and by whom direct support service is provided;
  • uses that information to identify outcomes the person desires; and
  • respects each person’s history, dignity, and cultural background;

Self-determination that supports and provides:

  • opportunities for the development and exercise of functional and age-appropriate skills, decision making and choice, personal advocacy, and communications; and
  • the affirmation and protection of each person’s civil and legal rights; and

Providing the most integrated setting and inclusive service delivery that supports, promotes, and allows:

  • inclusion and participation in the person’s community as desired by the person in a manner that enables the person to interact with nondisabled persons to the fullest extent possible and supports the person in developing and maintaining a role as a valued community member;
  • opportunities for self-sufficiency as well as developing and maintaining social relationships and natural supports; and
  • a balance between risk and opportunity, meaning the least restrictive supports or interventions necessary are provided in the most integrated settings in the most inclusive manner possible to support the person to engage in activities of the person’s own choosing that may otherwise present a risk to the person’s health, safety, or rights.

So, what does all of that mean? It means that every individual has a right to work toward what they want out of life. Quality of life means something different to everyone – some may value the opportunity to be around family members as the most important thing in their life, while others may say that working a job or being able to go on vacation are the most important things in their life.

What does it not mean? It does not mean that we look the other way while the person makes dangerous decisions or takes too many risks. Within the scope of services, it is still our responsibility to support the person in a way that reduces any known risks or vulnerabilities. However, we must not try to create sterile environments where day to day life for those we support is not remotely similar to what we would consider a “normal” life. We all balance risk with reward every day, right? That is what keeps our lives interesting and rewarding! It is how we learn, and also how we discover what is important to us.

When developing a support plan, we have to take into consideration two main categories. What is important to the person – communicated only by that person through their words or actions – and what is important for the person. What is important for the person are usually things that are developed by the team members who want the person to be safe and healthy. Too often, program planning is done solely on what the team believes is important for the person, and does not reflect significantly enough that person’s own desires and dreams.

It is important for everyone to feel safe in their own home, to have their thoughts and opinions listened to, and to have the opportunity to participate in what they enjoy doing. It is important that people feel connected to someone other than paid caregivers (who often come in and out of their lives very frequently). It is important for everyone to have a sense of belonging, and a sense of purpose. The individuals that receive support and services from Zumbro House are not different in this regard. Just like them, we also rely on others in our lives to give us feedback when we are making a poor decision, give us ideas when we are unsure which direction we should go, and help us to discover new and exciting things!

Please take a closer look at the individuals you are supporting and appreciate them for the interesting and unique individuals that they are. Help us discover how to best support them as they work toward their unique goals and dreams. Our jobs are so much more than filling in data tracking and writing reports! With person centered thinking and planning, we can support people in achieving their goals and dreams!

By signing below I acknowledge that I have received training on and have had an opportunity to ask questions regarding Person-Centered Planning as required under 245D licensing.

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